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mourning

Patton Oswald lost his wife. He describes it as the second worst day of his life. The worst day was when he had to break the news to his daughter. His reflections on loss and grief are vulnerable and insightful.

Paul wrote in an early part of his book about how quickly the medical students changed and that the, “Cadavers reverse the polarity. The mannequins you pretend are real; the cadavers you pretend are fake… to take one good look at our cadaver’s face and then to leave it covered; it makes the work easier.” (Kalanithi, 45) It’s facelessness quickly allowed what was once a person in whom life dwelled, a person who may have loved deeply and been deeply loved, to become instead pieces of a body. Although in this paper we look at Paul’s life as he approaches death to understand what has been learned both about living and the process of dying, let us not forget that Paul was real and his loss was deep. Loved by his wife, family and friends, he also left behind a future in his words, the lives he impacted and his young daughter newly created. It is in his words to his daughter, who will remember him only through others, that we see the title of our class captured so clearly:

When you come to one of the many moments in life where you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more but rests, satisfied. In this time, right now, that is an enormous thing. (Kalanithi, 199)

This kind of response to one’s own death might seem extraordinary to many, but it was sculpted by a lifetime of influences. His Christian father and Hindu mother had eloped from the south of India to New York City where he had been raised for a while before being moved to Arizona with his family. His mother’s concern about his education caused her to emphasize reading heavily at a very young age. Meanwhile, his father was deeply committed to his medical practice which meant that he was not frequently around, making Paul view the personal cost of medicine as too high early on in his life. However, these things would remain important threads throughout the story of Paul.

“Brave New World founded my nascent moral philosophy and became the subject of my college admissions essay, in which I argued happiness was not the point of life.” (Kalanithi, 27) After starting college he consumed literature courses in a search for human meaning but soon began to look into biology to understand the mechanisms that made creatures creators, ultimately moving over to the pursuit of a medical degree. And yet literature continued to shape how he tried to understand his patient’s experiences and, ultimately his own. “Neurosurgery attracted me as much for its intertwining of brain and consciousness as for its intertwining life and death… being so close to the fiery light of such moments only blinded me to their nature, like trying to learn astronomy by staring directly at the sun.” (Kalanithi, 81) The medical culture he was now immersing himself in caused him to struggle to respond as a person dying instead of as a doctor and yet his lifetime of seeking served him well in expressing his experience through the book he ended up writing and scoping out his purpose towards the end.

“It is the differences in meaning, far more than mere differences in vocabulary, that isolate cultures and that cause them to regard each other as strange or even barbaric. It is not too surprising that many cultures refer to themselves as “The People,” relegating all other human beings to a subhuman form of life.” (Barland, 39) This division by culture is easily identified when there are language barriers, differences in dress, or other ethnic markers that turn a comparison between people into a study in contrasts. Maybe it is just as likely that cultural misunderstandings occur when we are almost the same. There is so much to relate to Paul on that when I struggle to understand him, it is hard to remind myself of the cultural nuances. For instance, in a culture that requires 100 hours a week when you’re dedicating yourself to the care of other’s, perhaps a reduction of empathy is a means of survival whereas I, having never had such demands put on me, see only callousness. Paul, upon hearing that a friend died from a car accident after an attempt to save her life, wrote: “In that moment, all my occasions of failed empathy came rushing back to me: the times I had pushed discharges over patient worries, ignored patients’ pain when other demands pressed. The people whose suffering I saw, noted, and neatly packaged in various diagnoses…” (Kalanithi, 85)

Additionally, I wonder if I would have chosen to have a child before I died, leaving my spouse with a permanent reminder of myself and the possible burden of being both in mourning and a single parent simultaneously. His wife also asked him, “Don’t you think saying goodbye to your child will make your death more painful?” (Kalanithi, 143) It wouldn’t only be hard on her; they both struggled with the decision. It’s clear as you read that family is a strong value for him from the very beginning. If I had been his wife I think I would have wanted to have the baby. He writes in reply to her question regarding it being more painful, “’Wouldn’t it be great if it did?’ I said. Lucy and I both felt that life wasn’t about avoiding suffering.” (Kalanithi, 143) Indeed, loss is the cost of our commitment to one another sometimes; the price we pay for love. If loving someone more deeply was what made this death harder, perhaps that is the best way one could exit this world.

Another perspective would be that having the child was a form a denial that death was as imminent as he was being told. In fact, he wrote, “We would carry on living, instead of dying.” (Kalanithi, 144) Paul manifested denial differently than many of us might. He could not intellectually deny that he had cancer, or that he understood to at least some extent the severity. He had become the patient for the very things he treated. He writes: “After the diagnosis, I knew that someday I would die, but I didn’t know when. But now I knew it acutely.” (Kalanithi, 132) He undoubtedly felt it profoundly. But his denial was found in his actions. He stated that if he had a sense of the time he had left it would determine what he would do. Two years versus ten years mattered, but he knew she couldn’t give him what he was asking. It appears he was able to exist in a place where he was more acutely aware of his mortality while generally operating in denial until the birth of his daughter. “Yet there is a dynamism in our house. Day to day, week to week, Cady blossoms: a first grasp, a first smile, a first laugh… Time for me is now double-edged: every day brings me further from the low of my last relapse but closer to the next recurrence-and eventually, death.” (Kalanithi, 196)

Paul writes that he believes he went through the five steps of grief in reverse; that because he knew he was going to die but at the time was unable to know the when, instead of experiencing denial first, he experienced it last. Due to his vast medical experience in the field, he saw the stage of acceptance as being at the very beginning because he understood his prognosis. I would say that while Paul and Lucy certainly experienced that stages of grief, acceptance for them was at the end. “One of the most important aspects of Nearing Death Awareness is the need for reconciliation. Dying people develop an awareness that they need to be at peace.” (Callanan, 137) Before his diagnosis, his marriage was in danger of ending. In a way, the cancer brought healing. “Our relationship was still deep in meaning, a shared and evolving vocabulary about what mattered. If human relationality formed the bedrock of meaning, it seemed to us that rearing children added another dimension to that meaning.” (Kalanithi, 142) To that end, the other important part is legacy, that we have defeated death through our ability to continue on even after we have died. Paul and Lucy managed this aspect of their grief through their child and completing the book together.

These aren’t the only things that changed for Paul towards the end of his life. Voirst writes that “our dying may sometimes provide a new opportunity, that dying may sometime permit… growth and change, that dying may precipitate a further stage of emotional development that had – until now—been well beyond our capacities.” (Voirst, 318) At first he had thought that he could never do surgery again. In the end he realized that his doctor had done what he himself had strived to do with his patients: protect the attributes which they value and empower them to discover what they wanted to do with their remaining time. As he practiced surgery, he learned more about how his illness transformed him: “The tricky part of illness is that, as you go through it, your values are constantly changing. You try to figure out what matters to you, and then you keep figuring it out… Death may be a one-time event, but living with terminal illness is a process.” (Kalanithi, 160-161) In other words, dying is a process that at its best has you discovering who you are until the very end.

We come at last to consider the role that religious beliefs played in how Paul dealt with both being diagnosed and dying. Although certainly approached in a scientific and academic manner, Paul was not devoid of a relationship with God; he wrote that if he had known God sooner he would have perhaps pursued a pastoral role instead of the one he ended up in. The fact that he saw no proof of God left him in a place where believing in God seemed unreasonable and so he didn’t. It wasn’t that he didn’t have the foundation; he was familiar with Scripture and his family raised him Christian. After searching through much of his twenties, he reached the following conclusion:

“The problem, however, eventually became evident: to make science the arbiter of metaphysics is to banish not only God from the world but also love, hate, meaning-to consider a world that is self-evidently not the world we live in. That’s not to say that if you believe in meaning you also believe in God. It is to say, though, that if you believe that science provides no basis for God, then you must also be obligated to conclude that science provides no basis for meaning and, therefore, life itself doesn’t have any.” (Kalanithi, 169)

Paul reaches this conclusion and saw sacrifice, forgiveness and redemption as the foundational principles of Christianity. This was crucial to helping him deal with his situation, even if he doesn’t appear to lean on it very heavily. This is true also of his lens of seeing Jesus as delivering a message of mercy over justice. Christians understand that sacrifice is a part of their story; Paul responds to his loss of life, time and experience less with anger and more with a zeal to squeeze what he can out of what is left. While he strives, he is full of forgiveness and we see redemption is his relationships time and again.

Christian’s often define faith with language like “assurance of things hoped for, the evidence of things unseen,” similar to Hebrews 11:1. To this end, I don’t believe this is a struggle of Paul’s. The way he is built makes supernatural faith hard, but he sees evidence in the world around him that speaks to a Creator who wants our lives to have meaning and purpose. So while his faith might look different, that doesn’t make it any less deep. This is a man who, dying, chooses to create life. To write of his experience dying in order to help others. I do not see a struggle of faith in Paul; I see a man being faithful in his struggle, much like the man after which he was likely named.

I thought that this class on death would better equip me, but more often then not it highlights how ill-equipped we are to deal with death. How inadequate words are. How necessary the feeling are as you experience grief when you are the one dying or when you are the one who lives on after they’ve passed.

As I look back on past experiences with death, anger is so frequent and so stifled. Our professor says it is okay to be angry at God; that pastors or ministers often discourage it but it’s sometimes a place people have to move through.

I thought quite a bit about it and as I reflect on God’s character, I think my professor is right. As long as we take it TO God. As long as we have a dialogue with Him about what this loss means and what we do with how we are feeling and where His place in that is. Because ignoring anger doesn’t make it go away and stifling it doesn’t put out fires of that kind. However, if we tell people they can’t take their anger at God TO God, they end up taking it out on others.

Yet if we take what we are feeling TOWARDS God, TO God, how differently might things turn out? We get to pour out what we are feeling and maybe God will respond. Maybe your relationship with Him, like many that weather a storm, will be deepened. Take for example what Mary says, which sounds like there might be a little accusation mixed in with her mourning. Yet she takes it to Jesus:

When Mary reached the place where Jesus was and saw him, she fell at his feet and said, “Lord, if you had been here, my brother would not have died.” John 11:32

How about grief? Psalm 102 is a prayer of an afflicted person who then laments to God. Here’s just a tiny peak at what that looks like:

“Hear my prayer, Lord;let my cry for help come to you. Do not hide your face from me when I am in distress. Turn your ear to me;when I call, answer me quickly. For my days vanish like smoke;my bones burn like glowing embers.My heart is blighted and withered like grass; I forget to eat my food.” Psalm 102:1-4

See, I think what we see in that Bible is not that we aren’t supposed to feel the things that we feel when we mourn, but that we are supposed to feel it with God. Furthermore, I think that God is there with us in this mourning, whether we acknowledge Him or not (like the theologians I wrote about when looking at the Holocaust). I was at a lecture by Cath Livesay where she made the point that God doesn’t lose His voice, but we sometimes lose our ability or willingness to listen. You might call out for God while your heart still isn’t ready to hear what He has to say to you; just because you aren’t hearing from God doesn’t mean He isn’t with you.

As I walk through this class and the death I am surrounded by I realize how ill equipped the average Christian is for those who are dying and those who have lost someone to death. They might even experience shame over their own experience with grief. Perhaps we should consider Jesus’ response to the death of his friend as well as those in mourning:

When Mary reached the place where Jesus was and saw him, she fell at his feet and said, “Lord, if you had been here, my brother would not have died.” When Jesus saw her weeping, and the Jews who had come along with her also weeping, he was deeply moved in spirit and troubled. “Where have you laid him?” he asked. “Come and see, Lord,” they replied. Jesus wept.” John 11:32-35

Are some of us not able to relate to Mary in times of loss, going to God and saying, “Lord, if you had been here, this person I had love would not have died.” While it is true that Jesus later, because he was moved again, raised Lazarus from the dead, this was not his first response. Jesus’ first response was to weep with them. He mourned with them. He did not try to get them to skip over the natural state of broken heartedness at the loss of the person no longer sharing this life with them, or ignore the fact that their day to day life would be radically transformed by his absence. He wept with them.

“Blessed are those who mourn, for they will be comforted.” Matthew 5:4

It seems like terminal illness is a far more common thing that we realize. Perhaps because there’s a tendency for both the dying and the mourning to hide; they hide their illness or their loss, they mask their pain and so we think it far less common than it really is. There’s some similarities and differences between someone who has lost someone to a terminal illness and a person diagnosed with the illness but one thing they share is grief.

As the video, Living with Dying says, “Love and death are the two great gifts that are passed on, and usually they are passed on unopened…”[1] One son talked about how he knew his mother was going to die for three years and he thought he was prepared but he was wrong. The size of our grief, one could argue, is proportional to the amount of our love. The manifestation of that grief can either be physical, emotional or behavioral. Some of the more common physical symptoms I’ve heard mentioned is “…we often have a perceptual sense of unreality. Other people may actually appear to be father away from us than they are; they may appear small or dark. And there is generally an intense preoccupation with the image of the deceased, sometimes to the extent of experiencing an hallucination.”[2]

Emotionally, people could respond in alignment to previous readings on the 5 stages or go through a wide spectrum of responses. Anger towards the living by those diagnosed (thus antagonizing those closest to them) can push away those who are trying to help and leave the terminally ill in isolation. More unique to those left behind are possible feelings of guilt or hostility. Finally, you have the behavioral responses: “…we experience a marked inability to carry on the habits of customary living.”[3] For those experiencing loss, it could be due to the fact that it’s lost meaning now that the deceased is no longer there providing much of our purpose. For the diagnosed, facing the illness forces an evaluation of how to best use one’s time and to face the effects of the diagnosis.

Ultimately, to those who are grieving, the loss feels like an emergency. I’ve had my own friends talk about their frustration at the world continuing to move around them when this huge tragedy had occurred; I felt similarly when I went through my first major loss. Do these people not know how different the world is, I thought? Did they not feel the axis of my world shift… Similarly, the world of those facing a diagnosis seems the same. They face an invisibility where their illness is treated but they aren’t necessarily seen and those they love continue to live as they lived before. Meanwhile, the future they envisioned has been stolen. Even worse, as one man said in the Living with Dying video, “Many Americans I know have no support system and it’s due to the fact that the American family has become fragmented.”[4] Some don’t even have anyone to notice their life being stolen by a terminal diagnosis.

As Robert Neale writes, there is a close overlap between these experiences for the one who is experiencing the death: “The task of the bereaved is also the task of the dying… First, it means that the individual who knows or senses that he is dying is also himself bereaved… The second is that those who suffer their own loss have the same task as those who suffer the loss of someone else.”[5] Therefore, the greatest similarities are that the dying person experiences much of what the mourning person does, but the mourner does not understand the full state of the person facing a terminal diagnosis.

This video is a lecture by Rabbi Harold Kushner and he knows something about this topic. The video is going to seem dated, but there is a lot to be learned from what he has to say. It is nearly an hour long but I encourage you to find time for the whole thing. Some of it might feel encouraging, scary, healing, uncomfortable or even dangerous. I would just recommend taking it all in. I don’t think you’ll regret it.